Breggin, 2011 Psychiatric Drug-Induced Chronic Brain Impairment (CBI): implications for long-term treatment with psychiatric medication.

[Altostrata]

Dr. Breggin's next book, on prolonged withdrawal syndrome and other aspects of Chronic Brain Impairment, will contain the material below.

 

Int J Risk Saf Med. 2011;23(4):193-200.

Psychiatric drug-induced Chronic Brain Impairment (CBI): implications for long-term treatment with psychiatric medication.

Breggin PR.

 

Source

 

Center for Study of Empathic Therapy and Private Practice, Ithaca, New York, USA. PsychiatricDrugFacts@hotmail.com

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/22156084

Full text at http://breggin.com/index.php?option=com_docman&task=doc_download&gid=229&Itemid=37

 

Understanding the hazards associated with long-term exposure to psychiatric drugs is very important but rarely emphasized in the scientific literature and clinical practice. Drawing on the scientific literature and clinical experience, the author describes the syndrome of Chronic Brain Impairment (CBI) which can be caused by any trauma to the brain including Traumatic Brain Injury (TBI), electroconvulsive therapy (ECT), and long-term exposure to psychiatric medications. Knowledge of the syndrome should enable clinicians to more easily identify long-term adverse effects caused by psychiatric drugs while enabling researchers to approach the problem with a more comprehensive understanding of the common elements of brain injury as they are manifested after long-term exposure to psychiatric medications. Treatment options are also discussed.

 

 

From the paper:

....

5.1. Frequency of CBI

Psychiatric Drug CBI was relatively rare in the early decades of my career in psychiatry (I graduated medical school in 1962) when far fewer children and teens were treated with psychiatric drugs, when polydrug treatment was looked upon much more critically, when doctors rarely encouraged patients to stay on psychiatric drugs for the remainder of their lives, and when potent antipsychotic drugs were not given out so freely to patients with no signs whatsoever of psychosis. Undoubtedly, the widespread use of alcohol and illegal drugs, often taken in combination with prescription drugs, has helped turn CBI into an epidemic.

 

It is difficult to estimate what percentage of patients will develop CBI after years of exposure to psychiatric drugs. In my clinical experience, nearly all patients who remain on these chemical agents for many years will develop some symptoms of CBI. If the patient is taking multiple psychiatric drugs for years at time, in my experience CBI is always marked.

 

The most noticeable effects are short-term memory dysfunction and a loss of interest in daily activities, hobbies, creative endeavors, and sometimes family and friends. The clinician can inquire about creative activities requiring higher mental function, sensitivity to others, and spontaneity – such as art work, writing, music, close friendships, and sexual relations. Individuals exposed long-term to psychiatric drugs will commonly report a loss of interest, intensity or satisfying engagement in these activities. Sometimes they will deny their losses which are nonetheless confirmed by family members and loved ones.

 

....

5.3. Treatments for CBI

The initial and only effective treatment for CBI is complete withdrawal from all psychiatric drugs as well as all other psychoactive substances. During the withdrawal process, it is important to establish healthy living practices in regard to good nutrition (no special diets), moderate exercise, and sufficient rest and sleep.

 

Patients should be discouraged from turning to additional psychoactive substances, including herbs or natural remedies. They can worsen the CBI and interfere with a successful withdrawal process. The covert use of alcohol and illegal drugs will also impair withdrawal.

 

Close monitoring of the patient during drug withdrawal is required. In addition, the drug withdrawal process should be accompanied by supportive psychotherapy for both the patient and significant others who can provide support during the sometimes difficult process. Couples or family therapy is potentially the most effective. It can help the uninjured partner understand the struggle to triumph over brain dysfunction and strengthen the relationship in supportive ways for both partners. Cognitive-behavioral Therapy (CBT) can be useful in promoting better ways to think of responsibility and self-determination but nothing is more important than supportive relationships when brain function is impaired.

 

The patient’s subjective experience is the best gauge for pacing the withdrawal process. Utilizing a person-centered approach [29], it is best to start with a small dose reduction, and then to step-by-step make reductions dependent upon how the patient is responding. To reduce fear and anxiety, patients must feel in charge of the rate of the withdrawal process.

Any therapy that can produce emotional stress, such as insight therapy that explores childhood trauma, or couples therapy that deals with severe conflicts, should be delayed until the patient is able, willing and eager to take on these challenges.

 

Programs for cognitive rehabilitation are probably less effective than encouraging the individual to engage in useful, pleasurable and stimulating physical and mental activities. Encourage individuals with CBI to rediscover activities that they once loved. Frequently, they have given them up.

 

A recurrence or worsening of the individual’s psychiatric disorders is a major concern during withdrawal, especially in regard to individuals who have been made vulnerable by CBI. In my own experience, however, judicially and slowing removing long-term psychiatric drugs – along with appropriate psychotherapy – usually helps in recovery from psychiatric disorders.

 

After medication withdrawal, patients often declare, “I’ve gotten my life back. I’m myself again!” Family members often feel that they have regained the husband, wife or child that they used to know and love before the adverse medication effects set in. The work of psychiatric drug withdrawal, while sometimes difficult and hazardous, can be very gratifying to the clinician and extremely empowering to the patient and family.

Edited November 10, 2012 by Altostrata
added strikethrough

[Skyler]

I just ordered the book. This sounds like just what I've been looking for. Goo Doc Breggin. I'll give a review soon!

[alexjuice]

Honestly, I think the primary benefit of this book will be assisting doctors to understand these concepts. I can tell them all I want about the generalities, but I am not a doctor, haven't published, and base my notions things ie heard on the "patient forums".

 

It'd be ideal actually that a book elucidating these downside phenomena be written by anyone other than Healy or Breggin since I know a lot of my doctors consider them fringey and not worth thinking of -- this after they google them and learn they are not "mainstream".

 

The shipko book, if was greatly expanded to cover his experience working with "aftermath" cases, could be great. It's too narrow, I think, as is at 20 pages exclusive to Xanax withdrawal.

[Skyler]

Just saw my PC and he asked me to send him a link for the book. YES!

[Barbarannamated]

Has anyone read Grace Jackson's " Drug Induced Dementia" or Ann Blake Tracy's " Prozac, Panacea or Pandora?" ? Tracy also has a CD/MP3 on withdrawal. Her work is focused on serotonergics with an emphasis on antidepressants and violent crime. I have not read her info, but understand she advocates a very slow taper, slower than Breggin.

[Skyler]

Has anyone read Grace Jackson's " Drug Induced Dementia" or Ann Blake Tracy's " Prozac, Panacea or Pandora?" ? Tracy also has a CD/MP3 on withdrawal. Her work is focused on serotonergics with an emphasis on antidepressants and violent crime. I have not read her info, but understand she advocates a very slow taper, slower than Breggin.

 

A search of this site found a number of questions about various works by Ann Tracy, but no feedback from Alto herself??

[Altostrata]

I haven't read Ann Tracy's books or listened to her CD.

 

If there's anyone here more familiar with her methods, please start a topic about them.

[strawberry17]

I have Ann Tracy's book and read it earlier this year, it is very very heavy going and I found some parts too technical/scientific for me to understand, but parts of it were hugely hugely enlightening for me, especially the chapter about akathisia which contained loads of different quotes from loads of people describing how akathisa felt, it was a lightbulb moment for me, I realised what happened to me had a name. She read a bit of my blog and sent me a link to her CD via Facebook I think but I never could open the link and listen to it sadly.

[Altostrata]

Note: Contrary to expectations, Dr. Breggin's new book, Psychiatric Drug Withdrawal, does NOT address post-discontinuaton withdrawal symptoms.

 

I've corresponded at length with Ginger Breggin (Peter does not correspond with the public) and she says his Chronic Brain Impairment theory covers deterioration that starts post-discontinuation. In fact, Breggin attributes this to some other medical disorder and sends patients on the usual wild goose chase to find out why they're experiencing withdrawal symptoms:

Recovery from CBI usually begins early in the withdrawal process and can continue for some time, even years, after stopping all psychiatric medication. As the number of drugs and their dosages are reduced, patients show improvements in memory, engagement in activities, and mood stability. Because of anosognosia, the patient may not recognize the improvements as quickly or thoroughly as the prescriber, therapist, or family; but it would be unusual if the patient fails to notice or acknowledge any positive changes early in the drug withdrawal process.

 

If the patient does not begin displaying significant improvement in CBI symptoms during the drug withdrawal process, the clinician should suspect the presence of another underlying medical disorder, and take appropriate steps to ensure adequate medical evaluation. Psychiatric Drug CBI can be confused with or worsened by any additional disorders that impair brain function. The covert use of alcohol or illegal drugs can impair the withdrawal process.

So, withdrawal syndrome is thrown under the bus again, this time by Peter Breggin.

[Barbarannamated]

"Alcohol or illicit drugs.."?? He does not acknowledge that SS/NRIs can cause other chronic neurological or medical problems??

 

Wow.

[compsports]

Note: Contrary to expectations, Dr. Breggin's new book, Psychiatric Drug Withdrawal, does NOT address post-discontinuaton withdrawal symptoms.

 

I've corresponded at length with Ginger Breggin (Peter does not correspond with the public) and she says his Chronic Brain Impairment theory covers deterioration that starts post-discontinuation. In fact, Breggin attributes this to some other medical disorder and sends patients on the usual wild goose chase to find out why they're experiencing withdrawal symptoms:

 

Recovery from CBI usually begins early in the withdrawal process and can continue for some time, even years, after stopping all psychiatric medication. As the number of drugs and their dosages are reduced, patients show improvements in memory, engagement in activities, and mood stability. Because of anosognosia, the patient may not recognize the improvements as quickly or thoroughly as the prescriber, therapist, or family; but it would be unusual if the patient fails to notice or acknowledge any positive changes early in the drug withdrawal process.

 

If the patient does not begin displaying significant improvement in CBI symptoms during the drug withdrawal process, the clinician should suspect the presence of another underlying medical disorder, and take appropriate steps to ensure adequate medical evaluation. Psychiatric Drug CBI can be confused with or worsened by any additional disorders that impair brain function. The covert use of alcohol or illegal drugs can impair the withdrawal process.

So, withdrawal syndrome is thrown under the bus again, this time by Peter Breggin.

 

Can't say I am surprised. I just had a feeling this was going to happen even though it stinks to high heaven.

 

Have you considered posting this review on Amazon's site?

 

CS

[Altostrata]

What a great idea! Would you post it?

[compsports]

What a great idea! Would you post it?

 

I am confused. Do you want me to post what you wrote? How would I properly credit you if I was using my account?

 

Sorry if I am missing something.

[GiaK]

this underscores the FACT that the MDs who claim to know a lot about withdrawal really don't...

 

we, those of us who have spent YEARS on these boards have far more experience...(in terms of vast numbers of "patients")

 

MDs have their practices...small populations that they generalize from...not at all an understanding of the entire population of people in withdrawal at all!

 

we see thousands...they might MIGHT see hundreds...but probably not more than a couple hundred...

 

yup!!

[Altostrata]

So true, Gia. Also, Peter Breggin sometimes gets caught up in the glory of his own theories and doesn't let any inconvenient facts get in the way.

 

Sure, cs, copy and paste. No need to credit me in this situation.

[amg2012]

"If the patient does not begin displaying significant improvement in CBI symptoms during the drug withdrawal process, the clinician should suspect the presence of another underlying medical disorder, and take appropriate steps to ensure adequate medical evaluation."

 

Excuse me, as I certainly do not know as much as many of you on this board, but I do not understand why the above statement is negating that withdrawal syndrome exists? The way I read it is that improvement in CBI symptoms as quoted below, start to improve.

 

"The most noticeable effects are short-term memory dysfunction and a loss of interest in daily activities, hobbies, creative endeavors, and sometimes family and friends."

 

It was a short time (I am talking several weeks, not days) after I started my withdrawal that I was no longer as fatigued as I had been, memory improvement "began," emotions "started" to return, and I "began" to deal with things that I just couldn't handle before and I even did a little bit of creative stuff and remember being quite surprised of that. At the same time I was certainly still experiencing withdrawal symptoms.

 

My withdrawal was gradual and I am now over 1 week with no A.D. drug. I really feel now like my emotions have been unleashed and some of them are not nice. A lot of personal anger about my life that had been tamed by drugs is now in full force. I think of this as a good thing. This is something that I will deal with by taking action to remedy the situation, as opposed to "floating" through the rest of my life.

 

I know that I am still at risk of depression, and if you haven't read my poem on my "home" page, please do.

 

I was not on A-Ds for a consistently long time - for me it has been on and off them. Perhaps this makes a big difference, but I don't understand how what Breggin is saying as quoted, negates a belief in withdrawal syndrome??? Again, excuse me if I am unaware of or don't understand this.

[Altostrata]

Correct, amg. At best, Breggin is avoiding discussing post-discontinuation withdrawal symptoms.

[Barbarannamated]

Amg,

 

The terminology confused me, too. At first I thought he was using "CHRONIC Brain Impairment" to include prolonged or protracted effects after discontinuation. There are many people who are suffering disabling symptoms for years after finishing a taper. I didn't have disabling symptoms until about 6 months after my last dose. I had been on many different drugs for nearly 2 decades and a recent MRI did show brain lesions/cerebrovascular damage. That may be what Breggin is referring to with "underlying conditions" although he does not acknowledge that the drugs may have CAUSED that damage that is manifesting in prolonged symptoms (apathy, cognitive, perceptual, severe mood, in my case).

 

Dr. Stuart Shipko has offered his opinion directly to this group. He speaks of neurological damage (neurotoxicity) caused by SS/NRIs as comparable to industrial solvent neurotoxicity. He's seen recovery take approximately 5-10 years:

http://survivingantidepressants.org/index.php?/topic/677-communications-with-dr-stuart-shipko/page__fromsearch__1

 

You have done a careful taper, were on drugs for a relatively short time, and weren't polydrugged, so it makes sense that you're experiencing improvement already.

 

This is my take on Breggin's statements. His use of the term "Chronic" is, to me, very misleading.

 

I hope this makes sense.

[CymbaltaDrone]

So, withdrawal syndrome is thrown under the bus again, this time by Peter Breggin.

 

I read the entire paper and I didn't get the impression that this is what was happening. This paragraph seems to be a typical clinical statement about one of the signs - in Breggin's experience - that one may see indicating that they are dealing with more than just CBI (or possibly not CBI at all).

 

Breggin can only publish what he sees in his research. We as patients may have other experiences and so - rightly or wrongly - consider him to be wrong but what do we expect of the man? He is discounted enough as it is for even researching this and to overstep the bounds of his clinical experience and scientific research into anecdotes and conjecture would completely discredit him.

 

I'm grateful for every little bit of crusty crap his work chisels off the facade of our disease and if anybody is to be blamed for the lack of advocacy and care for us, I lay that blame squarely at the feet of the pharma companies, doctors and governments who either have no interest whatsoever in our wellbeing or at best take the easy way out and abdicate their responsibility to drugs. As did at least some of us patients in the first place.

[Altostrata]

The paper says

 

5.2. Recovery from CBI

Recovery from CBI usually begins early in the withdrawal process and can continue for some time, even years, after stopping all psychiatric medication. As the number of drugs and their dosages are reduced, patients show improvements in memory, engagement in activities, and mood stability. Because of anosognosia, the patient may not recognize the improvements as quickly or thoroughly as the prescriber, therapist, or family; but it would be unusual if the patient fails to notice or acknowledge any positive changes early in the drug withdrawal process.

 

If the patient does not begin displaying significant improvement in CBI symptoms during the drug withdrawal process, the clinician should suspect the presence of another underlying medical disorder, and take appropriate steps to ensure adequate medical evaluation. Psychiatric Drug CBI can be confused with or worsened by any additional disorders that impair brain function. The covert use of alcohol or illegal drugs can impair the withdrawal process.

Breggin can't say CBI is improved by discontinuation and not address even worse symptoms that appear AFTER discontinuation. That amounts to a denial of post-discontinuation withdrawal symptoms and prolonged withdrawal syndrome.

 

He's made other contributions, but this is not helpful.

[CymbaltaDrone]

Fair enough. I see your point - especially since I'm not even sure if what I'm experiencing is CBI or something else / worse.

 

From a scholarly article point

[CymbaltaDrone]

Sorry - child interference!

 

From a scholarly article point of view though isn't the standard process to examine each condition/symptom in isolation? While I can see that this is not necessarily helpful to most sufferers who have other things going on, it seems to be a lose-lose situation for Breggin.

[Altostrata]

Breggin likes to produce Theories of Everything.

 

I would have taken it as you suggest -- a study of a condition in isolation -- except that when I corresponded with Breggin through his wife (and assistant) Ginger, she said CBI is how he explains post-discontinuation symptoms.

 

Not even Peter Breggin can have it both ways!

[aza]

this underscores the FACT that the MDs who claim to know a lot about withdrawal really don't...

 

we, those of us who have spent YEARS on these boards have far more experience...(in terms of vast numbers of "patients")

 

MDs have their practices...small populations that they generalize from...not at all an understanding of the entire population of people in withdrawal at all!

 

we see thousands...they might MIGHT see hundreds...but probably not more than a couple hundred...

 

yup!!

 

Dom't Doctors sit down with their peers and discuss this stough? Seems that if they compared notes about these populations they should see a correlation, so what's up?

[GiaK]

 

 

Dom't Doctors sit down with their peers and discuss this stough? Seems that if they compared notes about these populations they should see a correlation, so what's up?

 

they don't...they don't even acknowledge this is going on...who are they going to talk to?

 

the numbers of doctors who have a clue about withdrawal is very very small and most of them don't know each other.

[alexjuice]

this underscores the FACT that the MDs who claim to know a lot about withdrawal really don't...

 

we, those of us who have spent YEARS on these boards have far more experience...(in terms of vast numbers of "patients")

 

MDs have their practices...small populations that they generalize from...not at all an understanding of the entire population of people in withdrawal at all!

 

we see thousands...they might MIGHT see hundreds...but probably not more than a couple hundred...

 

yup!!

 

I've given thought to recommending to my current psychiatrist, Dr. Y, that she consider specializing in post-psychiatric-drug trauma. I'd direct her here, for starters.

 

From an economic standpoint, it makes a lot more sense that being just another psychiatrist. On the other hand, from a public perception perspective, I think it's a tough sell. I'll probably never bring it up. Once my taper is finished and I no longer need to play the game to get the benzos, I'll probably just say, "Goodbye. Have a good life."

 

So, for a while anyway, the sufferers on the net will remain the true experts and we'll try to help those out of charity after psychiatrists injure them at great profit. IMO.

[GiaK]

it is a tough sell...though as you point out...if they take it on those of us who need an MD who has a clue would be flooding their doorstep...

 

I wrote a "plea to prescribing docs" trying to make the sell...

 

it it's ever appropriate it can be shared with our doctors:

 

A plea to prescribing physicians and psychiatrists: please help us heal

http://beyondmeds.com/2012/11/11/plea-to-prescribing-mds/

[Altostrata]

I hear through the grapevine that the Breggins think the single negative Amazon review for his book -- from a disappointed patient who sounds to me like she has a valid point -- was generated by his enemies. They are rallying his friends to vote up the other positive reviews so the negative review will be buried.

[GiaK]

totally valid...I felt that way about all his withdrawal books...they read like horror stories and when you're withdrawing you really don't need that crap. As she says...we know they're horrible and toxic etc...lets underscore the positives of getting off...that we might get off, rather than continue to ruminate on how we've been poisoning ourselves...

 

she says:

 

I purchased this book with high hopes for finally getting some MEDICAL advice on stopping this drug safely and without committing any crimes. What I got instead was a lot of info about all of the ways in which this drug is bad. Okay, already knew that. What I did NOT get was any workable solution for me. His answer to pretty much every type of medication withdrawal is family therapy.

 

and though I've not read this one his prior books are pretty useless in terms of how one can give oneself meaningful support.

 

I agree with her completely.

 

it's really quite sad that meaningful criticism is not at all processed.

[compsports]

totally valid...I felt that way about all his withdrawal books...they read like horror stories and when you're withdrawing you really don't need that crap. As she says...we know they're horrible and toxic etc...lets underscore the positives of getting off...that we might get off, rather than continue to ruminate on how we've been poisoning ourselves...

 

she says:

 

I purchased this book with high hopes for finally getting some MEDICAL advice on stopping this drug safely and without committing any crimes. What I got instead was a lot of info about all of the ways in which this drug is bad. Okay, already knew that. What I did NOT get was any workable solution for me. His answer to pretty much every type of medication withdrawal is family therapy.

 

and though I've not read this one his prior books are pretty useless in terms of how one can give oneself meaningful support.

 

I agree with her completely.

 

it's really quite sad that meaningful criticism is not at all processed.

 

Also, the person starts off stating, "OK let me start by saying that this book SHOULD be read by all physicians who are considering prescribing psychiatric medications for their patients. The book explains in lurid detail how bad these drugs are and all the types of irreversible damage they do to our brain."

 

Yeah, that really sounds like this review was generated by his enemies

 

Sheesh, Breggin sounds just as bad as the psychiatrists who think all criticism is from scientologists. It is the just the opposite side of the coin with same absurd argument steeped in denial that doesn't want to deal with meaningful criticism.

 

CS

[GiaK]

I wanted to add that I do actually empathize with Breggin as far as his choice to use the automated form letter response to email.

 

I have to do the same thing. Once ones public profile reaches a certain level it's truly impossible to keep up with email. I know that my policy upsets people too. I do not accept private correspondence at all these days. This was triggered by the fact that I'm very ill and really can't do it, but at this point when I'm healthy again I will keep the policy in place because I frankly don't want to spend 40 hours or more a week answering email...and yes...it does get that intense when you have hundreds of people emailing you.

 

People really don't appreciate how much time it takes to respond to 100s of emails. It's impossible if you want a life.

[Altostrata]

I understand. That's why I request that people ask questions in this forum format!